09 Jun Poutineville

Last Name / Nom de Famille

First Name / Prénom

Service Number / Numéro de Service

Rank / Rang

E-mail

Phone Number / Numéro de Téléphone

Member Status / Statut du Membre

Meal Option / Choix de Repas

Hat Trick (fries,cured cheese,bacon,ground beef,hot dogs,house gravy) Classic (fries,curd cheese & house gravy) Vegetarian (fries,curd cheese,,mushrooms,onions,peperes,olives,pepper sauce gravy)

Cost / Coût

Member - $5 Non-Member - $15

Acknowledgement that $5.00 will be deducted from the members pay if the meal is not picked up between 11:30 -12:30

YES / Oui I AM A RESERVIST/ASSOCIATE - if unable to pay upon pick up MY ACCOUNT WILL BE CHARGED $5 THAT I WILL PAY VIA E-TRANSFER OR IN THE CLERKS OFFICE

Privacy Notice

I confirm that I have read the PRIVACY NOTICE.

Consent agreement

By registering to this program or activity, I consent to the collection and use of my personal information as described in the privacy notice above.

09 Jun Poutineville

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